Fluids and Electrolytes Flashcards
Third spacing manifestations
- Decreased urine output
- Increased heart rate
- Decreased BP, Decreased CVP
- Edema
- Increased weight
What is the most important assessment for electrolyte balance?
Daily weight *
Nutritional, health history, meds
Fluids move with
Osmosis
Sodium potassium pump
How the body regulates sodium by active transport
Intracellular fluid (ICF)
Fluid inside cell
Extracellular fluid (ECF)
Fluid outside of cell
- Intravascular
- Interstitial
- Transcellular
Intravascular fluid
contains plasma, liquid part of blood
Interstitial fluid
Surrounds cell, lymphatic
Decrease in oncotic pressure
loss or decrease is plasma albumin (pregnancy)
results in EDEMA
Increase in capillary permeability may be caused by
- Inflammation
-Immune response (burns, crushing injuries, neoplastic disease, cancer, allergic reactions)
results in EDEMA
Increase in hydrostatic pressure may be caused by
- Venous obstruction
- Sodium and water retention
results in EDEMA
Reasons for abnormal fluid movement
- Decrease in oncotic pressure
- Increase in capillary permeability
- Increase in hydrostatic pressure
- Obstruction of lymph channels
results in EDEMA
Obstructions of lymph channels may be caused by
- Tumors
- Inflammation
- Surgical removal
results in EDEMA
Kidneys
major filter
must have enough pressure for kidneys to do their job!
hypothalamus
gives perception of thirst
adrenal cortex
regulates sodium by releasing aldosterone
(where Na goes, water flows)
pituitary gland
releases/inhibits adh (holding/letting go of water)
If a patient has any issues with their these 4 things, fluid will not be balanced (How fluids are regulated)
adrenal cortex
hypothalamus
kidneys
pituitary gland
Lung edema
pleural effusion
Cardiac edema
pericardial effusion
belly edema
ascites
feet edema
peripheral edema
edema everywhere
anasarca
With edema, what should you make sure your assessment includes?
compare bilaterally
Complications of edema
- Pressure injuries
- Infections
- Life threatening influence (brain, lungs, larynx)
Transcellular fluid
cerebral spinal, pleural
Isotonic
iso means same
-given to replace fluid loss
- 280-300
-D5W, NS, LR
hypotonic
fluid going inside, cells swell (hippo)
osmolality is lower than plasma (<280)
hypertonic
fluid going outside, cells shrink
osmolality is higher than plasma (>300)
Osmolality
Concentration of all chemical particles found in the fluid part of the blood
Normal osmolality levels
280-300
If sodium is low, osmolality will be
LOW!
Factors decreasing osmolality
(Less than 280)
- Fluid volume excess!
- SIADH
- Renal failure
- Hyponatremia (low na, low osm.)
- Overhydration
Use D5W (hypotonic) with caution in
patients with diabetes
neuro patients (brain swelling)
cerebral edema
What is the only solution that can be given with blood?
normal saline
What symptom do you need to watch for when giving NS
shortness of breath!!
Use NS with caution in
patients with renal impairment
CHF
pulmonary edema
What do you need to monitor in patients receiving a hypotonic solution?
LOC
Hypotonic solutions
think low numbers!
1/2 NS
1/3 NS
1/4 NS
D2.5W
Use hypertonic solutions with caution in patients with
diabetes
impaired heart or kidney function
hypertonic solutions
think high numbers!
5% Dextrose, 10% dextrose
most common colloid
albumin
what do colloids do?
pull fluid into the bloodstream
Monitor patients when infusing colloids for
fluid overload
-increased bp
-dyspnea
-bounding pulse
-anaphylaxis
monitor electrolytes if giving diuretics
fluid volume deficit causes
vomiting – HOW LONG
dehydration – HOW LONG
trauma
burns
diuretics
fluid volume overload causes
rapid infusion rate
hepatic, cardiac, or renal disease
more common in elderly
fluid volume overload prevention
infuse IVF via pump
monitor closely
fluid volume overload intervention
decrease iv rate
monitor vs, respiratory status
high fowlers
Normal sodium levels
135-145
chloride follows
sodium
function of sodium
maintains proper balance of water and minerals
-BP
-Blood volume
-pH balance
Hyponatremia causes
“NONA”
-Na excretion w renal problems, NG suction, vomiting, diuretics, sweating, diarrhea, DI
-Overload of fluid
-Na intake low (low salt diet, NPO)
-Antidiuretic hormone oversecretion (SIADH)
sodium is regulated by
ADH
Aldosterone: hold Na in body by blocking it at kidney
Sodium potassium pump: moves Na out of cells
S/S of hyponatremia
(lots of neuro)
SALT LOSS
Seizures and stupor
Abdominal cramping, attitude changes (confusion)
Lethargic
Tendon reflexes diminished, trouble concentrating
Loss of urine & appetite
Orthostatic Hypotension, Overactive bowel sounds
Shallow respirations
Spasms of muscles
rule of thumb for treating hyponatremia
serum Na must not be increased >12 meq/L in 24 hours
treatment for hyponatremia (water gain)
restricting h2o is safer than giving Na
(restrict 800ml/24hr)
diuretics
hypertonic solution
Patients on lithium with low Na
can get lithium toxicity due to urinary sodium loss
hypernatremia causes
(HIGH SALT)
Hypercortisolism
Increased intake of sodium
GI feeding without adequate water
Hypertonic solutions
Sodium excretion decreased with corticosteroids
Aldosteronism
Loss of fluids
Thirst impairment
Hypernatremia S/S
(FRIED) neuro*
Fever, flushed skin
Restless, really agitated
Increased fluid retention
Edema, extremely confused
Decreased urine output, dry mouth/skin
Hypernatremia treatment
decrease serum Na level gradually (0.5 over 48 hrs)
monitor for neuro changes
hypotonic solution
desmopressin
Potassium levels
3.5-5
Potassium is a major electrolyte in
intracellular fluid
Hypokalemia causes
(body is trying to DITCH potassium)
Drugs – #1 cause, diuretics, laxatives, corticosteroids
Inadequate consumption of K
Too much water intake
Cushings Syndrome
Heavy fluid loss
Hypokalemia S/S
everything is going to be LOW and SLOW
*** lethal cardiac dysrhythmias
-weak pulse
-shallow respirations
-confusion, weak
-lethargy
-lots of urine
-low bp and heart
renal system is important in keeping balanced
potassium (potassium leaves body by kidneys)
body does not conserve
potassium
it can still leave body by urine if levels are low
renal loss of K
diuretics - loop, thiazides
hyperaldosteronism
high dose sodium pcns
large dose corticosteroids
Increased aldosterone causes
an increased retention of Na and water & increases urinary excretion of potassium
hypokalemia cardiac changes
** decreased strength of contraction
digoxin toxicity and potassium
low blood levels of potassium
oral K+ supplements
minimize GI irritation
give with food!
IV K+ supplement
DO NOT give IVP
must be diluted
must use IV pump
max dose - 60meq at a time
HYPERkalemia causes
CARED
Cellular movement (ICF to ECF)
Adrenal insufficiency
RENAL FAILURE - #1 cause
Excessive potassium intake
Drugs - Ace, Beta, NSAID
HYPERkalemia S/S
MURDER
Muscle weakness
Urine production little to none
Respiratory failure
Decrease cardiac contractility
Early signs of muscle twitches/cramps
Rhythm changes
HYPERkalemia cardiac changes
slows heart rate (bradycardia)
ECG changes
HYPERkalemia treatment
cation-exchange resins
POLYSTYRENE SULFONATE (KAYEXALATE)
meds containing potassium
ace inhibitors
beta blockers
NSAIDS
Ca gluconate
does not lower potassium
helps protect heart
Magnesium levels
1.6-2.6
magnesium maintains
regulates muscle and nerve fx
blood sugar levels
immune system
*normal cardiac fx
hypomagnesemia is associated with
hypokalemia
low mg makes low k resistant to treatment!!
Hypomagnesemia S/S
tight airway! (ABCs)
difficulty swallowing, stridor
N/V/D
increased BP and HR
Most common cause of hypomagnesemia
chronic alcoholism
Nursing interventions for hypomagnesemia
SIM
Safety with swallowing
IV mg + sulfate
Monitor respiratory status
foods rich in mg
dark choc
avocado
milk
peas
peanut butter
oranges
nuts
bananas
Hypermagnesemia S/S
heart- calm and quiet
Lung - low and shallow
hypoactive bowels
lethargy
weak
Causes of hypermagnesemia
antiacids
renal failure
potassium excess
nursing interventions for hypermagnesemia
HIM
Hemodialysis
IV calcium gluconate
Monitor labs
